Medicare for All, the Bernie Sanders Version

Since I’ve spent so much time discussing the extensive details of Elizabeth Warren’s Medicare for All plans (let’s call it WarrenM4A), I think this week it’s time I talked about Bernie Sanders’ M4A plans (SandersM4A). These are the only two leading Democratic candidates who are advocating M4A.

Like I did for my analysis of Elizabeth Warren’s plans, I will rely only on what Bernie Sanders has committed to on his official campaign website. He’s made it easy for me because there is very little on there. Here are the direct quotes of all relevant information from his website (here and here):

“Create a Medicare for All, single-payer, national health insurance program to provide everyone in America with comprehensive health care coverage, free at the point of service.”

“No networks, no premiums, no deductibles, no copays, no surprise bills.”

“Medicare coverage will be expanded and improved to include: include dental, hearing, vision, and home- and community-based long-term care, in-patient and out-patient services, mental health and substance abuse treatment, reproductive and maternity care, prescription drugs, and more.”

“[Make] sure that no one in America pays over $200 a year for the medicine they need by capping what Americans pay for prescription drugs under Medicare for All.”

“Allow Medicare to negotiate with the big drug companies to lower prescription drug prices with the Medicare Drug Price Negotiation Act.”

“Allow patients, pharmacists, and wholesalers to buy low-cost prescription drugs from Canada and other industrialized countries with the Affordable and Safe Prescription Drug Importation Act.”

“Cut prescription drug prices in half, with the Prescription Drug Price Relief Act, by pegging prices to the median drug price in five major countries: Canada, the United Kingdom, France, Germany, and Japan.”

“Eliminate all of the $81 billion in past-due medical debt held by 79 million Americans —one in every six Americans.”

“The federal government will negotiate and pay off past-due medical bills in collections that have been reported to credit agencies.”

“Reform bankruptcy laws to use the existing bankruptcy court system to provide relief for those with burdensome medical debt.”

“End abusive and harassing debt collection practices.”

That’s it. I didn’t quote all his specifics about how he will get rid of medical debt and reform bankruptcy laws, but that is less relevant to a discussion about the future function of the healthcare system itself under his SandersM4A.

My brief summary of those quotes: he’s going to cover everyone with Medicare; he will enhance Medicare’s benefits to include dental, hearing, vision, long-term care, etc.; there will be no out-of-pocket expenses for services; he will use a variety to means to lower prescription prices significantly plus cap out-of-pocket spending on prescriptions to $200/person/year (I assume he is not meaning $200/person/medication/year); and he will negotiate and pay off all existing medical debts.

We see here the same simplicity that WarrenM4A offers, for both patients and providers. That is, after all, one of the main draws of M4A in general–it’s probably the simplest way to cover everyone.

Let’s talk briefly about how SandersM4A will deal with drug prices. Medicare will be allowed to negotiate, which it will be able to do very successfully when it covers all 300-something million of us. We will also be allowed to buy drugs from other countries for those times when, despite Medicare’s negotiations, other countries’ prices are still lower than ours. And then, confusingly, he also says he’s going to peg drug prices to the median prices of some other countries. This doesn’t sound like negotiation, so I’m not sure how it fits with his promise to get Medicare to negotiate drug prices.

Regardless, he is leveraging known successful methods of lowering prices–increase supply, and increase (and also take advantage of!) your bargaining power. This is very similar to what WarrenM4A proposes, which you can review here.

Unfortunately, that’s about as much as I can say about SandersM4A. There’s no discussion about how he would transition, nor how he would set prices, which is probably politically prudent (although frustrating). He’s getting rid of all cost sharing, which seriously impedes the opportunity to stimulate value-improving innovations over time, as I’ve written about before. But, who knows, maybe he would implement many of the other pricing features I’ve described to achieve an optimal single-payer system and thereby prevent the unfortunate demise I have predicted for WarrenM4A.

I’ll repeat myself one final time: M4A can be implemented without much thought about or understanding of the realities of market mechanisms, or it can be implemented in a way that leverages those market mechanisms to also fix healthcare for the long term. So far, I’m not seeing any evidence of the latter from these candidates.

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